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Permit CITY OF TIGARD ORIGINAL PLUMBING PERMIT ,; DEVELOPMENT SERVICES PERMIT #: PLM2000 -00231 `�'�" „� II 13125 SW Hall Blvd., Tigard, O R 9722 (503) 639 -4171 DATE ISSUED: 06/21/2000 SITE ADDRESS: 12208 SW SWEENEY PL PARCEL: 2S103AB -05300 SUBDIVISION: WALNUT GLEN ZONING: R -4.5 BLOCK: LOT: 011 JURISDICTION: TIG CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES: TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS: 1 OCCUPANCY GRP: R3 FLOOR DRAINS; TRAPS: STORIES: WATER HEATERS: CATCH BASINS: FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS: SINKS: URINALS: GREASE TRAPS: LAVATORIES: OTHER FIXTURES: TUB /SHOWERS: SEWER LINE: ft WATER CLOSETS: WATER LINE: ft DISHWASHERS: RAIN DRAIN: ft Remarks: Installation of residential backflow device FEES Owner: Type By Date Amount Receipt STEVE DURRANT PRMT GWL 06/21/200C $25.00 0003179 12208 SW SWEENEY PL 5PCT GWL 06/21/2000 $2.00 0003179 TIGARD, OR R 9722397223 Total $27.00 Phone 1: 624 -9599 Contractor: OWNER REQUIRED INSPECTIONS Phone 1: RP /Backflow Preventer Reg #: This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 0001 -0010 through OAR 952 - 0001 -0080. You may obtain copies of these rules or direct questions to OUNC by calling (503) 246 -1987. Issued By: l 4l Permittee Signature: no; / Call (5 ) 639 -4175 by 7:00 P.M. for an inspection needed the next business day CITY OF TIGARD Plumbing Permit Applicatio Plan Check# 13125 SO HALL BLVD. Commercial and Resident CE�� Rec'd By t✓ ; ) TIGARD, OR 97223 Date Recd (a - 1 4 -1= (503) 6394171 JUN 19 200 Date to P.E. Print or Type Date to DST Incomplete or illegible applications v not DEVELOPMENT Permit # F�a1LDOO- c9G 3f Related SWR # Called Name of Development/Project FIXTURES (individual) QTY PRICE AMT Job Wn knu.. Gken Sink 11.50 Address Street Address PG Suite Lavatory 11.50 Bldg �� )gy Tub or Tub /Shower Comb. 11.50 Idg # City /State Zip Shower Only 11.50 i ��0.� ��' c� a.3 Water Closet 11.50 Name S 1.)la.. rt-..0 A- Urinal , 11.50 Owner Mailing Address J� �s nr Suite Dishwasher 11.50 &W Si AlrK'1,) Garbage Disposal 11.50 Cit Zip Phone c raCA O(z. q,��(Sb3) 4 ,s 9 Laundry Tray 11.50 N a l Washing Machine /Laundry Tray 11.50 Floor Drain/Floor Sink 2" 11.50 Occupant i li @�$� Suite 3" 11.50 City/State �� Zip Phone • 4" 11.50 Water Heater 0 conversion 0 like kind 11.50 Name Gas piping requires a separate mechanical permit. MFG Home New Water Service 32.00 Contractor Mailing Address Suite MFG Home New San/Storm Sewer 32.00 Hose Bibs 11.50 Prior to permit City/State Zip Phone Roof Drains 11.50 issuance, a copy Drinking Fountain 11.50 of all licenses are Oregon Const. Cont. Board Lic.# Exp. Date required if Other Fixtures (Specify) 15.00 expired in COT Plumbing Lic. # Exp. Date database Name Architect Sewer - 1st 100' 38.00 Or Mailing Address Suite Sewer - each additional 100' 32.00 Water Service - 1st 100' 38.00 Engineer City/State Zip Phone Water Service - each additional 200' 32.00 Describe work to be done: Storm & Rain Drain - 1st 100' 38.00 New 0 Repair 0 Replace with like kind: Yes 0 No 0 Storm & Rain Drain - each additional 100' 32.00 Residential 0 Commercial 0 Additional description of work: Commercial Back Flow Prevention Device 32.00 Residential Backflow Prevention Device' ----7 19.00 Catch Basin 11.50 Are you capping, moving or replacing any fixtures? Insp. of Existing Plumbing or Specially Requested 50.00 Yes 0 No 9 Inspections per/hr If yes, see back of form to indicate work performed by Rain Drain, single family dwelling 45.00 fixture. FAILURE TO ACCURATELY REPORT FIXTURE Grease Traps 11.50 WORK COULD RESULT IN INCREASED SEWER FEES. QUANTITY TOTAL I hereby acknowledge that I have read this application, that the information Isometric or riser diagram is required if Quantity Total is > 9 given is correct, that I am the owner or authorized agent of the owner, and *SUBTOTAL th plans submitted are in compliance with Oregon State Laws. SI a re of O gent ' ate o g o..0to 8 /° SURCHARGE �� C � -+ , c � t verso ame Phone TSi'G�� �� (ooL/'Qs-9 "'PLAN REVIEW 25% OF SUBTOTAL 1 BATH HOUSE $178.00 Required only if fixture qty. total is > 9 2 BATH HOUSE $260.00 TOTAL r'Y-I 3 BATH HOUSE $285.00 • (This fee includes all plumbing fixtures In the dwelling and the first "Minimum permit fee is $50 + 8% surcharge, except Residential Backflow Prevention 100 feet of sanitary sewer storm sewer and water service) Device, which is $25 + 8% surcharge "All New Commercial Buildings require plans with isometric or riser diagram and plan review. I:tdsts forrnslplumapp.doc 11/18/99 PLEASE COMPLETE: Fixture Type Quantity by Work Performed New Moved I Replaced Removed /Capped Sink Lavatory Tub or Tub /Shower Combination Shower Only Water Closet Urinal Dishwasher Garbage Disposal Laundry Room Tray Washing Machine Floor Drain /Floor Sink 2" 3" 4" Water Heater Other Fixtures (Specify) COMMENTS REGARDING ABOVE: C1dsts forms plumapp.doc 11/18/99 8/21/00 Activities for Case #: PLM2000 -00231 3:48:40 PM • Assigned Hold Updated Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes PLMA003 Application received 6/19/00 MAIL RECD No Hold GWL 6/21/00 PLMA005 Create Permit 6/21/00 GWL DONE No Hold GWL 6/21/00 PLMA750 RP /Backflow Preventer No Hold GWL 6/21/00 PLMA050 (F) Issue permit 6/21/00 GWL DONE No Hold GWL 6/21/00 PLMA055 (F) Reprint Permit f 8/15/00 ZZZ DONE No Hold ZZZ 8/15/00 • • • • Page 1 of 1 CITY OF TIGARD BUILDING INSPECTION DIVISIO 24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 MS BUP Date Requested ,3 f AM 117 r PM BLD Location / 2 i or .5 4 1/ st✓P -.c / l Suite ME Contact Person / Ph G Z7- .5"-.f f 42,7 Z3( Contractor Ph SWR BUILDING Tenant/Owner ELC Retaining Wall ELR Footing Access: Foundation FPS Ftg Drain SGN Crawl Drain Inspection Notes: Slab SIT Post & Beam Ext Sheath /Shear Int Sheath /Shear Framing Insulation Drywall Nailing Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling Roof I Misc: 1 Final / PASS PART FAIL . ' .PLUI�I�IN � /j Beam o B . II Under Slab Mil - • . Top Out Water Servi Sanitary Sewer Rain ains in ASS PART FAIL ANICAL Post & Beam - 7 Rough In Gas Line Smoke Dampers Final PASS PART FAIL ELECTRICAL Service Rough In UG /Slab Low Voltage Fire Alarm Final PASS PART FAIL SITE Backfill /Grading Sanitary Sewer Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd Catch Basin Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access ADA Approach /Sidewalk 3) �/' � Date / Inspector Ex t' Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site.